My 3 year-old twin SWCAH daughter died 6/23/99 due to an adrenal crisis and in less than 24 hours from onset of the illness.  She had vomited 3 times the day before, but was holding down all fluids with no vomiting since right before dinner that evening (fever below 101 through all this).  There are many of us on this board (and other adrenal insufficiency boards) who have lost a child due to CAH.  Regarding adrenal crisis, broken bones - I believe that it is that a CAH person can go into 'near immediate shock' and very quickly from a broken bone or severe physical injury.  An adult once posted on the Addison's adrenal insufficiency board that he had an adrenal crisis from pulling a muscle in his leg when bowling.  Many adults (CAH & Addison's) say they can have an adrenal crisis from "emotional stress" (no illness).  One female adult went into a crisis over the stress of planning her daughter's wedding.  Regardless of what anyone says, I will always believe an adrenal crisis can occur from emotional stress.  You can't give "too much" cortef (regarding doubling or tripling the dose when suspecting your child has an illness or onset of illness.  We once met with an endo who treated adults only, the man was brilliant - and he said to double the dose with even a cold, we do that (.. surviving twin is SWCAH too).  I double a dose with any fever below 101, and triple with any fever 101 or above, triple with ANY vomiting, if that triple dose doesn't stay down OR child exhibits ANY symptoms of adrenal crisis (i.e. seems tired/lethargic, just doesn't look herself) - give the injection.  An oral dose may not be absorbed in a high fever alone, vomiting illness (even if that dose isn't vomited for even 8 hours), or diarrhea ... the stomach can shut down the absorption process completely, this is a natural phenomenon of the stomach so that the body energy (glucose) can be used for other body processes (fighting the illness, breathing, oxygen to the brain).   Several CAH people have "just suddenly quit breathing" (and died) during an illness (adrenal crisis things not known by the caretaker at the time).  One child who died was believed to have food poisoning, and he had just vomited once the night before, and was in a coma in the morning.  We had an incident about 9 months ago, my daughter's fever spiked up near 104 within 2 hours after giving a triple cortef dose for a fever running around 102.4, Motrin and Tylenol, everything tried wouldn't bring it down, Amanda began to look lethargic/listless.  Called the endo and she said to give the injection and come into the hospital (still no vomiting).  Gave the injection and in the car ride to the hospital, she began perking up, one hour later at the hospital, the fever was back down in the low 100's, we were fine from then on (they did give 1 bag IV fluids), Amanda (age 6) repeatedly said giving the shot made her feel better.  Regardless of what any endo says, I firmly believe to not ever rely on the oral cortef working, and that the injection may need to be given for just a high fever (no vomiting) - but our endo (and many others) do say to inject for just a high fever.  During the night/sleeping times seem to be culprit times of many CAH children who died ... if any vomiting the night before or during the night, or any fever (especially 100 or above which can go up so quickly), watch the child for adrenal crisis symptoms, stay up all night with the child, or set the alarm hourly if you have to do that, just don't ever think the child could wait until the morning for a doctor or hospital trip, CAH children don't seem to "wait well" through the night - be prepared to head for the hospital in the middle of the night if the need be.